International journal of cardiology
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To assess the left ventricular function of patients who suffer from post-infarction angina and left ventricular failure in the coronary care unit, 79 consecutive survivors (mean age 48 years) of a first acute myocardial infarction were prospectively studied and followed-up for a mean 18- (10-34) month period. Forty-seven had an uncomplicated infarction, 17 suffered from post-infarction angina and 15 had left ventricular failure. The left ventricular function of these patients prior to discharge from hospital was assessed by cross-sectional echocardiography and radionuclide angiography. ⋯ New infarction was seen in 2 (12%) and 1 (7%) patients in these groups, respectively. We conclude that the left ventricular function of patients who suffer from post-infarction angina in the coronary care unit is good, but is impaired in those with even transient left ventricular failure. Echocardiographic assessment of cardiac function prior to hospital discharge was highly successful and may be performed in all such patients.
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We evaluated the accuracy of continuous wave Doppler for estimating pulmonary arterial systolic pressure in patients with tricuspid regurgitation. Of 44 patients with a variety of cardiac disorders, 39 (89%) had Doppler-detected tricuspid regurgitation. Adequate spectral profiles of the flow signals were obtained in 34 of them (87%), representing 77% of the entire group. ⋯ Continuous wave Doppler constitutes a sensitive method for the detection of tricuspid regurgitation. The method using the tricuspid gradient provides an accurate estimation of pulmonary arterial systolic pressure. Combined with other available methods (pulsed wave Doppler), this noninvasive technique can yield information comparable with that obtained at catheterization.
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Case Reports
Acquired pulmonary atresia following placement of modified Blalock-Taussig shunt in tetralogy of Fallot.
A 6-month-old infant developed pulmonary atresia following placement of a modified Blalock-Taussig shunt for tetralogy of Fallot with absent left pulmonary artery. This condition was diagnosed by failure of opacification of the pulmonary trunk and the right pulmonary artery following an injection of contrast in the right ventricle. At surgery the pulmonary valve was shown to be patent and free of calcifications. Acquired pulmonary atresia may complicate the clinical course of young children following the construction of a modified Blalock-Taussig shunt.
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We have discovered an interesting account of sudden death reported in the Liber Eliensis, a Latin compendium of twelfth century happenings in the environs of Ely, the cathedral town found just north of Cambridge in the fenlands of England. The account tells how Gervase, a Norman official of the Sheriff, oppressed the local Saxons. The abbot took the people's part and was summoned before Gervase. ⋯ Etheldreda, struck him with her staff in the chest. He woke with pain, crying out that St. Etheldreda was about to strike him again, and died.
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Comparative Study
Comparison of fibrinolytic treatment with interruption of the inferior caval vein in the prevention of pulmonary embolism.
The procedure of interruption of the inferior caval vein is designed to prevent pulmonary embolism, but its effectiveness has yet to be compared with thrombolytic therapy. Sixty patients hospitalized for pulmonary embolism and proximal deep vein thrombosis were divided into two groups of 31 and 29 patients, respectively. The patients were selected because of persistent venous thrombosis in the inferior caval, iliac or femoral veins. ⋯ This study demonstrated a high recurrence of pulmonary embolism in patients with persistent venous thrombosis who were treated by interruption of the inferior caval vein. These patients also had a high morbidity. Fibrinolytic treatment (even in the presence of persistent venous thrombosis) appeared to be more effective in avoiding recurrence of pulmonary embolism.